Seizing on the momentum of the presidential election and the promise of change on a historic scale, a grassroots "conversation" about health care reform under the Obama administration began Thursday with town hall meetings around the nation, including several in the Bay Area.

With some 47 million uninsured people in the United States, health care in the last few years has become a leading domestic preoccupation, taking center stage throughout the presidential race. In his campaign, President-elect Barack Obama pledged universal coverage and a health care overhaul, calling it a "moral imperative."

The Thursday town hall program, held in Washington, D.C., and at a dozen locations around the country including Oakland and Palo Alto, was designed to focus on top priorities for reform.

"We have a great opportunity to fix the two biggest problems: lack of coverage and the rising cost of care," said Alice Rivlin, a senior fellow at the Brookings Institution. Her session, at the National Press Club in the nation's capital, was telecast to the other sites. "Unless we fix them both, we're in trouble."

The central challenge, said participants both locally and in Washington, is how to fix a monumentally complex and costly health system amid a nose-diving economy.

Obama's plan to expand coverage would cost an estimated $75 billion annually, according to a new analysis by the PricewaterhouseCoopers' Health Research Institute.

That massive sum would cover two-thirds of the people who are currently uninsured. About $25 billion "would come from existing funding for the uninsured ... the rest will have to be raised through repealing tax cuts, raising taxes or limitations on other spending," said the report released this month.

"The employer community is ... desperate for health care reform," said R. Bruce Josten, executive vice president for government affairs at the U.S. Chamber of Commerce, who spoke in Washington. He noted that employers are subsidizing health insurance for 177 million people in the United States. "The business community is looking for transformational change."

The Thursday gatherings, sponsored by PricewaterhouseCoopers LLP and the National Association of Children's Hospitals and Related Institutions, corresponded with a survey released Thursday that shows a vast national expectation for major health care legislation during Obama's first term.

The top priority for Americans is lower health care costs, according to the poll by PricewaterhouseCoopers and the Children's Hospitals association. In contrast, the highest priority for health care industry leaders is expanded access to coverage. The survey sampled 1,800 people, including about 800 policymakers and executives of hospitals, pharmaceutical firms and insurance companies.

In Oakland, panelists at the town hall meeting voiced optimism for national health change, though a few speakers said they worried that bipartisan politics might impede the process.

"We need to make sure that reform takes place," said Dr. Gena Lewis, a pediatrician at Children's Hospital Oakland and a health care advocate. She said the public should be "noisy" in urging politicians to push for change.

The morning discussion covered a litany of topics including physician reimbursements, undocumented immigrants, advantages of single-payer health systems, and the importance of transparency when it comes to medical errors.

Panelists and public participants offered numerous suggestions to transform health care: adequate reimbursement to doctors; elimination of pre-existing conditions as a consideration for coverage; increased funding for medical research; shoring up of in-home medical services; a requirement that healthy young people have health insurance to balance out the overall cost.

Profit should be stripped from health care, said Dr. Candida Brown, a pediatric neurologist at Children's Hospital Oakland. "That will be very hard to do in our capitalistic society," she noted wryly.

Lisa Nelbach, a Berkeley biomedical researcher who attended the session, lived in Canada for a handful of years and found its health delivery far more efficient. She said she wants big change in the United States, "not hot air."

Panelist Crystal Gariano offered a perspective from two vantages: She works as an administrative coordinator of the neurosurgery department at Children's Hospital Oakland and is the parent of a girl with cancer.

"It is hard enough to fight a disease that is as terrifying as pediatric cancer," said Gariano, a Pleasant Hill resident whose daughter was diagnosed last year at age 9 with a soft-tissue cancer. "We're not used to the idea of health care as a basic right. That's the way most of the world views it."